Trazodone dosage

A 12-year-old boy taking elonidine 100 mierograms three times daily and dexamfetamine 15 mg twiee daily was preseribed trazodone 50 mg at bedtime. After a few weeks his trazodone dosage was inereased to 100 mg at bedtime. Within 45 minutes of taking his first inereased dose he had a hypotensive episode with bradyeardia and sedation. The trazodone dose was ledueed baek to 50 mg, but the drug was diseontinued 2 weeks later beeause of low blood pressure. ... 

The effects of buspirone are decreased when the drug is administered with fluoxetine Increased serum levels of buspirone occur if the drug is taken with erythromycin or itraconazole Should any of these combinations be required, the dosage of buspirone is decreased to 2.5 mg BID, and the patient is monitored closely. Venlafaxine blood levels increase with a risk of toxicity when administered witii MAOIs or cimetidine There is an increased risk of toxicity when trazodone is administered with the phenothiazines and decreased effectiveness of trazodone when it is administered with carbamazepine Increased serum digoxin levels have occurred when digoxin is administered with trazodone There is a risk for increased phenytoin levels when phenytoin is administered witii trazodone... 

MISCELLANEOUS ANTIDEPRESSANTS. An uncommon but potentially serious adverse reaction of trazodone is priapism (a persistent erection of die penis). If not treated within a few hours, priapism can result in impotence The nurse instructs the patient to report any prolonged or inappropriate penile erection. Use of the drug is discontinued immediately and the primary care provider notified. Injection of a-adrenergic stimulants (eg, norepinephrine) may be helpful in treating priapism. In some cases, surgical intervention may be required. Venlafaxine may cause an increase in die blood pressure. A sustained increase in die blood pressure may indicate that die dosage of venlafaxine needs to be decreased. 

Although trazodone has not received an FDA indication for use in children and adolescents, it has enjoyed some success in the treatment of disruptive behavior disorders in this population. An aggressive 15-year-old male inpatient was treated with trazodone at a dosage of 200 mg/day, which resulted in decreased disruptive behavior. Following discharge from the hospital, trazodone was discontinued and the patient s violent behavior resumed. Upon return to his previous dose of 200 mg, the aggressive behavior again remitted (Fras,... 

Frequent Extrapyramidal effects anticholinergic effects Occasional Galactorrhea menstrual changes drowsiness postural hypotension anorexia rash tardive dyskinesia Rare Blood dyscrasias lenticular deposits and opacities (with long-term high dosage) ECG abnormalities convulsions neuroleptic malignant syndrome TRANYLCYPROMINE, see MAO inhibitors TRAZODONE... 

The incidence of this interaction is unknown. All the evidence suggests that some patients require a moderate inerease in warfarin dose when starting trazodone. Be aware of this interaetion in all patients taking warfarin if trazodone is started or stopped, and adjust the dosage if necessary. The interaction can occur within a few days. The elinieal relevance of the 12% decrease in 5-warfarin levels see with nefazodone is likely to be minor. The authors of the study eoneluded that no ehange in warfarin dose is likely to be required on eoneurrent use. ... 

The interaction between clonidine and the trieyelics is established and clinically important. The incidence is uncertain but it is not seen in all patients. Avoid concurrent use unless the effects can be monitored. Increasing the dosage of clonidine may possibly be effective. The clonidine dosage was apparently successfully titrated in 10 out of 11 hypertensive patients already on amitriptyline or imipramine. Only clomipramine, desipramine and imipramine have been implieated so far, but other tricyclics would be expected to behave similarly (amitriptyline, nortriptyline and protriptyline have been shown to interact in animals ). The tetracyclic antidepressants maprotiline and mianserin do not generally appear to interact with clonidine. The isolated case of hypotension with trazodone is of unknown general importance. 

A case report describes a patient treated with trazodone, isocarboxazid and methylphenidate who developed symptoms of the serotonin syndrome. The US manufaeturer says due to the absence of clinical experience, if MAOIs are diseontinued shortly before or are to be given concurrently with trazodone, therapy should be initiated cautiously with a gradual increase in dosage until optimum response is achieved. However, the UK manufaeturer of trazodone says possible interactions with MAOIs have occasionally been reported they do not recommend concurrent use, nor should trazodone be given within 2 weeks of stopping an MAOI. MAOIs should not be taken within one week of stopping trazodone. ... 

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